Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Neurology, Clinical Research Development Unit (CRDU) of Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran.
Clin Ther. 2024 Nov;46(11):e10-e20. doi: 10.1016/j.clinthera.2024.08.014. Epub 2024 Sep 12.
Acute ischemic stroke (AIS) is a life-threatening condition demanding prompt reperfusion to salvage brain tissue. Thrombolytic drugs, like tenecteplase (TNK), offer clot dissolution, but time constraints and contraindications limit their use. Mechanical thrombectomy (MT) revolutionized AIS treatment, especially for large vessel occlusions (LVO). Recent evidence suggests that administering TNK before MT improves recanalization and outcomes, challenging the dominance of alteplase.
Relevant articles focusing on TNK before MT were retrieved from PubMed, Scopus, and Web of Science, looking for randomized controlled trials (RCT), clinical trials, and meta-analyses in humans until 2024.
TNK, a genetically engineered thrombolytic, exhibits superior fibrin specificity and a longer half-life than alteplase. Clinical trials comparing TNK and alteplase before MT showcase enhanced recanalization, functional outcomes, and safety with TNK. Advanced neuroimaging aids patient selection, though its cost-effectiveness warrants consideration. Dosing studies favor a 0.25 mg/kg dose for efficacy and reduced complications. Clinical guidelines from various associations acknowledge TNK's potential as an alteplase alternative for AIS treatment, particularly for LVOs eligible for thrombectomy.
In conclusion, TNK emerges as a promising option for bridging therapy in AIS, displaying efficacy and safety benefits, especially when administered before MT. Its fibrin specificity, longer half-life, and potential for improved outcomes position TNK as a viable alternative to alteplase, potentially transforming the landscape of AIS treatment strategies. While limitations like small sample sizes and variations in protocols exist, future research should focus on large-scale RCT, subgroup analyses, and cost-effectiveness evaluations to further elucidate TNK's role in optimizing AIS management.
急性缺血性脑卒中（AIS）是一种危及生命的疾病，需要迅速进行再灌注以挽救脑组织。溶栓药物，如替奈普酶（TNK），可以溶解血栓，但时间限制和禁忌症限制了其使用。机械血栓切除术（MT）彻底改变了 AIS 的治疗方法，特别是对于大血管闭塞（LVO）。最近的证据表明，在 MT 之前给予 TNK 可以改善再通和结局，挑战了阿替普酶的主导地位。
从 PubMed、Scopus 和 Web of Science 中检索了关于 MT 前 TNK 的相关文章，寻找 2024 年之前在人类中进行的随机对照试验（RCT）、临床试验和荟萃分析。
TNK 是一种基因工程溶栓药物，与阿替普酶相比，具有更高的纤维蛋白特异性和更长的半衰期。比较 TNK 和阿替普酶在 MT 前的临床试验显示，TNK 可增强再通、功能结局和安全性。先进的神经影像学有助于患者选择，但需要考虑其成本效益。剂量研究倾向于使用 0.25mg/kg 的剂量以获得疗效和减少并发症。来自不同协会的临床指南承认 TNK 作为 AIS 治疗的阿替普酶替代药物的潜力，特别是对于适合血栓切除术的 LVO。
总之，TNK 作为 AIS 桥接治疗的一种有前途的选择，显示出疗效和安全性的优势，特别是在 MT 之前给予时。其纤维蛋白特异性、更长的半衰期和改善结局的潜力使 TNK 成为阿替普酶的可行替代物，可能改变 AIS 治疗策略的格局。虽然存在样本量小和方案差异等限制，但未来的研究应侧重于大规模 RCT、亚组分析和成本效益评估，以进一步阐明 TNK 在优化 AIS 管理中的作用。
